Stereotactic Techniques In Clinical Neurosurgery

Various textbooks on stereotactic neurosurgery have been published during the last few years (Riechert 1980, Schaltenbrand and Walker 1982, Spiegel 1982), all of them dealing with functional stereo tactics as the major subject in the field. Diagnostic and therapeutic stereotactic interventions are only briefly described, whereas localization techniques are not yet mentioned. Since 1980, however, an increasing number of reports has been published on CT guided and computer monitored stereotactic performances which enable the surgeon to combine diagnostic and therapeutic efforts in one session. With recent progress in scanning techniques, including high resolution CT, NMR, and PET imaging of the brain, it has become possible to study and localize any brain area of interest. With the concomitant advances in computer technology, 3-dimensional reconstruction of deep seated lesions in stereotactic space is possible and the way is open for combined surgery with stereotactic precision and computer guided open resection. This type of open surgery in stereotactic space is already being developed in some centers with the aid of microsurgical, fiberoptic, and laser beam instrumentation. With these advances stereotactic techniques will rapidly become in tegrated into clinical neurosurgery. Stereotactics has become a metho dology which enables the surgeon to attack deep seated and subcortical small tumors. Neurosurgeons may abandon therapeutic nihilism, still frequently seen in glioma treatment, in the near future when stereotactic resection will be feasible and remaining tumor cells may be killed by adjuvant treatment modalities still in development.

This text presents a comprehensive and state-of the-art approach to stereotactic and functional neurosurgery. Overarching sections include achieving stereotactic precision, defining trajectories and targets, the biophysics of stereotactic therapies, diseases and targets, and the future of functional neurosurgery. Each section is designed to be inclusive of all relevant topics, serving as an unbiased resource to new clinicians in this field or established clinicians that are aiming to better understand complementary methods. Importantly, each section and the associated chapters can be used by basic and translational scientists as well as engineers and industry to better understand and deliver innovation to the field. Chapters within each section methodically analyze traditional and recently emerging concepts and techniques; address underlying principles with examples drawn from specific diseases and applications; and cover patient selection, target selection, available stereotactic methods, nuanced surgical methods, and clinical evidence across treatment options. Written by experts in each area, Stereotactic and Functional Neurosurgery is a definitive guide to the latest developments in stereotactic targeting, electrode implantation, surgical treatment of neurological and psychiatric disorders, the renaissance of stereotactic lesions, and the frontier of restorative neurosurgery for a variety of disorders that have no other therapeutic options.

Since its introduction about sixty years ago, stereotactic and functional neurosurgery has evolved into a fascinating and interdisciplinary endeavor that combines modern neurosurgery, neurobiology, and neuroimaging with innovative diagnostic and treatment strategies. In this collection, acknowledged experts from Europe and North and South America present their scientific and clinical experience in stereotactic and functional neurosurgery for movement disorders and brain tumors. The contributions present a wide range from the beginnings of human stereotactic neurosurgery to the most modern molecular and restorative strategies to treat diseases of the human nervous system. They clearly demonstrate that the discipline is still young and dynamic with alternative and sometimes competing strategies whose evaluation is underway. They also document that operative lesioning techniques such as thalamotomies, though still chosen under certain circumstances, have been succeeded by novel neuromodulation techniques such as deep brain stimulation in the great majority of clinical cases.

This volume offers a comprehensive discussion of the stereotactic frames, frameless systems, and radiosurgical procedures utilized in the treatment and control of movement and neurological disorders, Parkinson's disease, chronic pain, spasticity, tumours, epilepsy, and arteriovenous malformations.

Soon after neurosurgery had advanced past the stage of that older neurosurgeons will consider their cra removing lesions on the surface of the brain, it became niotomies quite adequate for the relief of many neu apparent that subcortical diseased tissue could not be rological disorders that Professor Kandel shows so excised safely by the usual surgical techniques because clearly to be amenable to stereotactic intervention, of the risk of damaging overlying normal structures. there are many lesions that undoubtedly can be reached Various means of reaching deep-seated lesions were more easily and with less risk to life and limb by ster devised, most of which attempted to approach the eotactic than by open procedures. pathological tissue through "silent areas" of the brain. This book is not just a description of operative However, these operations often resulted in serious procedures, although it does give clear accounts of neurological deficits. Spiegel and Wycis's modifica surgical techniques. It presents the postoperative histo tion of the Horsley-Clarke apparatus to reach targets ries of patients who have been cured or markedly re deep in the human brain introduced a new approach to lieved of longstanding afflictions; these persons have subcortical surgery. True, as Professor Edward Kandel been followed for 10 to 15 or more years, so that the relates, Russian surgeons had pioneered in the field, results may be considered more or less permanent.

These proceedings from the Xth Congress of the European Society for Stereotactic and Functional Neurosurgery in Stockholm reflect the growing interest in these fields of neurosurgery. It is the most extensive volume in this series of publications and it contains a large number of original articles pertaining to the most recent advances in stereotactic and functional neurosurgery. Not long ago stereotactic neurosurgery was considered an esoteric sub speciality practised only by those involved in treating movement disorders and pain. In the last decade we have witnessed the incorporation of stereotactic methodology in the management of common neurosurgical diseases, and the stereotactic technique is now practised in all major neurosurgical centers. As with other surgical techniques and tools, however, the utilization of stereotactic methods requires special knowledge and training. This book comprises articles which give insight into new stereotactic applications and technology. For example, the usage of stereotaxis without a frame and the so-called navigator systems in open tumor surgery is dealt with in two papers. The introduction and development of radiosurgery is closely linked to the advancement of stereotactic technique. Radiosurgical treatment of tumors and cerebrovascular diseases has been one of major achievements in modern neurosurgery. This publication contains several original reports illustrating the efficacy of radiosurgery in problematic neurosurgical diseases.

As in any multiauthored textbook penned by When I was first approached by the publisher of this volume, Martinus Nijhoff, Boston, I writers of diverse backgrounds and interests, explored the possibility of writing a personal Modern Stereotactic Neurosurgery to some monograph on contemporary stereotactic extent suffers from incompleteness. Future surgery. After a review of available literature, volumes no doubt will include many additions several aspects became apparent. First, no cur from other authors who also are important rent, readily accessible, multiauthored text de specialists in the field. Because not all authors signed to survey the field was available. Those write in the same style (or even language), we books that were available tended to heavily have attempted to achieve a more cohesive text emphasize theory, physiology, and anatomy. in the editorial process. Each chapter has been Second, stereotactic surgeons were considered subdivided into pertinent headings for easier abstruse and for too long were relegated to a reference. Because of my own background, status outside of the mainstream of neuro some readers will note an Americanization (as surgery. This attitude probably reflected the opposed to anglicization) of the chapters. insufficient explanation of the practical uses While many chapters comprise primarily sum and advantages of stereotactic technique. maries of the authors' work within the field, Third, in recent years, the field has expanded each author was encouraged to review the liter so rapidly that it has become a major compo ature in that discipline if appropriate.